Permit CI TY OF TIGARD PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00483
ref 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/25/2004
SITE ADDRESS: 09600 SW FREWING ST PARCEL: 2S102CD -00400
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: R -4.5
BLOCK: LOT: 025 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS; CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
• SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 50 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: New Sewer connection.
FEES
Owner:
Description Date Amount
DOWD, LARRY + LAURA
9600 SW FREWING [PLUMB] Permit Fee 10/25/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 10/25/2004 $5.80
Total $78.30
Phone:
Contractor:
LANDFIX CONSTRUCTION
744 WISTERIA ST
INDEPENDENCE, OR 97351 REQUIRED INSPECTIONS
Phone : 503 Sewer Inspection
Final Inspection
Reg #: LIC 161275
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by callin• 503)
246 -6699.
Issued By: Permittee Signature: ��
Call (503) 639 -4175 by 7:00 P.M. for an inspection n eded the next busi a ss day
Buildjng Fixtures
Plumbing Permit Application FOR OFFIC USE ONLY . -
City of Tigard C El \ V / E D R eceived 9 y /
�t (�
Date /By: /D L1 U Y ' .�Z Permit N � liV �d y J
13125 SW Hall Blvd., Tigard, Off3 13125 SW Hall Blvd., Tigard, OR 9 23 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /0.411 A I f . Date/By: Other Permit No ?7 ` -
(� 7rn y 02)
24- Hour Inspection Line: 503.639.41730 I 2 5 2004 6 . I Date y:
Jur s 'h I 2 for
Internet: www.ci.tigard.or.us �. ed /Met S Se Page 2 for
g Notified/Method: lV Supplemental Information
>'Y• "4 'a 3u`. K 7 r 5 ."F_ "x' Y 4ii °.': "' ;?y'd?L:s -
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N ' V ' 1 � ;MI: ®'' a � _ , :w mtu ;; €e ' _ :1 a 8.._ > i; 1 e.4'(, : _-.€ EE ". .
❑ New construction : � Demolition For special information use checklist.
5 IV jt$tZ Y N� Description 1 Qty. Ea. I Total
❑ Addition/alteration/replacement ® Other: PLUm5106 New 1-2-family dwellings (includes 100 ft. for each utility connection)
's'. @ •s a,� `t , ? - .r�:.�a,� = zFa. ��,�z: `�z; �ea�s';:s,saw� "�a�n�„ �4`�s�,� -'S
VW, " ; " r C OF G N STRIJCT ° . - . ', RN
a4 ti m OY- Wa :. -Z SFR (1) bath 249.20
� �:�fs ��:. _ ' ' 9:�:�t: :.nom �a�•s�3•:�...., viz, *.s��+�. .�-x �::�r.�..� :..w:. �:�'� �•�„ `^�'�,. � s.b ?�.k
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ® Other: P�m a ��
V Fire sprinkler ( sq. ft.) Page 2
§'+" 'a1� �, � ! 97 �t' �ac�'.; h�? ?. ��? :a•.�•.;..;'��t•3:�as�;.�5:;t3 `"�'5.;�'= a�..:•,.;.`'%a,�`>. ''''.4.7 w-
,,,; JO B;S E INFORMATION AND L ®CATION :
t
� .� ` � _. ��.a ;4r. ,,,I,XIA.rIi A P�. ��_;�,. ors <v w(, °`t Site utilities
Job site address: e tt/ - 1/') 1 Catch basin or area drain 16.60
City/State /ZIP: 7-7‘..-76112.17 l O2. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: /0i) ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
, 'fat,. - z.: { >,. ° .q 4::,_. , ;::�:.< ,;�.:v ;r:t:•, ~ ° :.; :.; Absorption valve 16.60
�, �" • i DESORhP IO} O WORK } $ ' "� Backflow preventer Page 2
Firs L (P Tb 0 ig- ✓ '1J ki-- Backwater valve 16.60
60 f 24/ 7n7 ' 7-7, 6 pre 5 24 Ji Clothes washer 16.60
Dishwasher 16.60
U.,...14,414-4.4.4m-4;:41.4 � it :., . -. � , _ ,T� <..: , _ ,- * , , .�.IF„ Drinking fountain 16.60
, ° > , RPI)RT OWN 4 ` . � : TEI\ A
�% ��, e ..� '«, . < ��r- . z��, ' � -`'., sN Ejectors /sump 16.60
Name: \ '>5 {-C p
Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone
(5(23 ) cca,Zy _5U Fax ( ) Garbage disposal 16.60
glow , 7 ` 0016 LI ' � D GO AC .ER Ol Hose bib 16.60
Ice maker 16.60
Business name: / -r� +,w �q,� tly-X p! ' ' C t /M t / V / (1_
Interceptor/grease trap 16.60
Contact name: � /'� �J / Medical gas (value: $ ) Page 2
7�� GU In
Address: w � 0. cS Primer 16.60
City/State /LIP: lYY�,wyjri7��2 /2CQ 1 /Y/ 0/73 5
Roof drain (commercial) 16.60
Phone: (5,3) 502._ R'r,1 ) ' " �I Fax: : ( ) p -a : / Sink basin /lavatory 16.60 -
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
I: 4 l +i "�g ' t '4 _ '�. CONTR R - -V x,. Water closet 16.60
Business name: .5 Vil-Yvi e � 141-p7 Water heater 16.60
Address: G t Other:
Subtotal
City/State /ZIP: Minimum permit fee: $72.50
( Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
V / p CCB Lie.: l6,`a7S Plumbing Lic. no.: G,'PQ
0 Plan review (25% of permit fee)
` n �� S' v
Authorized signature: �State surcharge (8% of permit fee)
_.,�G TOTAL PERMIT FEE
Print name: --- -pw ✓ [ 0� Date: /01/04 � This permit application expires if a permit is not obtained within
J� / ?� v 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\ Building \Permits\PLMF- PermitApp.doc 12/03 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard ,
Page 2 - Supplemental Information
Fee Schedule: Residential Fire' Suppression Systems:
�slte ,.,.r �;� >�. nth �... � . ,#:�. �5�?"' �.. � �..; ', �: c: ..: :z" ; °,. ... _
t1;Y-1t1eS Qty Fe (ea) Toialu' y -.
k,. ... ;: Square k'ootage PermiitFee;
Footing drain - 1s 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 _ $220.00
Sewer - 1st 100' 55.00 7,201 and greater . $309:00
Sewer - each additional 100' 46.40 .,
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 "°
Valnat<ori`„ Permit Fee::;A"
Storm & Rain Drain - 1st 100' 55.00
$1.00 to $5,000.00 • Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
+ tUre UrTMitem 3 Q�1 Pee T� add ucting $1 O or fraction thereof, to and
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 '$379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 orfraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees*. r 5 ' , ; s Quant y(Eixture) GVorlcPerformecf=.
Fixture Type t a z# 1 414 ° Replae 0
'•.�'...i QS't� 3
t t %e Ex��nn capp Comments regarding fixture work:
il4 7:�_'e9' .��.. �C"b,�'.., Sacra. -"
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall _
-Drive Then
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain /sink - 2"
-3"
-4 „
Car Wash Drain •
Garbage Domestic -
Disposal - Commercial *Note: If the fixture work under this permit results in an
Industrial increase of sewer EDUs, a sewer permit will ,be issued and
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) fees'assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink Bar/Lavatory •
Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor • Plan Review
Water Closet - Toilet • Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
•
•
\ Budding \Permits\PLM- PermitApp.doc 3/03
_ ,
ALOHA SANITARY SERVICE
INVOICE NO.
8600 SW Hillsboro Hwy., Hillsboro, OR 97123 9106
503 -644 -2797 * 503 - 648 -6254 * 503 - 639 -5188
/ ,
NAME: % - d " —�'—
ADDRESS: //7 ) _ , � p
CITY�' , : % - d�. •9.h� STATE: ZIP: / / 35 /
/ HOME: < 237 - '57A 9 WORK: _ CELL:
Joe SITE: - . ``•■ ,.-d t /. _ ! " ( /Mr'
'!� t /P.O. #:(•
t,-,; r 7
PAID BY CHARGE ❑ CHEC I CASH ❑ CREDIT CARD ❑
DATE / 0 - Z7 _ 6 5/ DRIVER p 714/4 2 ! AMOUNT
PUMP SEPTIC TANK ..Z5 (STD
❑ LINE OPENING
❑ INSPECTION FEE I
❑ SERVICE CALL
❑ LABOR, LOCATING, DIGGING, BACKFILL r - Y
❑ MATERIAL - ---
/
- - THIS Is NOT A SEPTI SYSTEM INSPECTION REPORT - - TOTAL $ 2,570 an
IY
- - REMARKS -
TYPE OF TANK: EEL ❑ ONCRETE ❑ PLASTI ❑ HOMEMADE ❑
HORIZONTAL ❑ VERT ❑ - RECTANGLE ❑ ❑ OTHER .
SIZE OF TANK: 350 ❑ 500 ❑ 750 ❑ 10 s (c❑ 1250 ❑ 1500 ❑ 2000 ❑ ' 3000 ❑ -°
LID LOCATION: INLET ❑ OUTLET 0 MIDDLE ❑ E NTI R E T OP ❑
TANK CONDITION: GOOD ❑ FAIR ❑ POOR ❑
FITTINGS: BAFFLES ❑ CONCRET ❑ CAST IRON ❑ P I PLASTIC ❑
NEEDS NEW LID? YES ❑ SIZE
GROUND COVER OVER TANK
Z \ . . .
COMMENTS ON CONDITION OF DRAINFIE ETC. /A, 1
.. -/ /.4 I
w
SIGNED BY DATE A .. z 7 „6 C'
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /b — - 7 AM PM v BUP
Location 9 6.6() Suite MEC
Contact Person Ph ( ) PLM •=1)49 - 00 qe3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing 3o?-- --- R'a 1 / ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain , �y�
•
Slab Inspection Notes: , 1 (/ / • SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling % 7fr —
Other:
/ 1
Othe
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sewer ��
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
PART FAIL
otE6HANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 11 Please call for reinspection RE: ❑ Unable to inspect – no access
Fire Supply Line
ADA X73
Approach /Sidewalk Date (�/ Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL